Permanent Case Worker Social Services

Case Manager Social Worker

Manage the medically related social and emotional needs of patients and their families as needs impinge on patient medical conditions, treatment, recovery, and safe transition from one level of care to another. Coordinate care with physicians, nursing staff, case managers, and allied health professionals ensuring that patient outcomes are achieved within established timeframes and with maximum efficiency in resource utilization. Conduct high-risk screening, initial and ongoing psychosocial assessments. Ensure continuity of care through case management and discharge planning, providing social work interventions to expedite timely discharges, monitoring patient outcomes, and analyzing variances. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include Neonate, Pediatric, Adolescent, Adult, and Geriatric age groups.

Detailed responsibilities include:

• Patient safety-related policies, procedures, and protocols
• Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings, and workshops
• Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
• Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
• Identify appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review, risk screens, and referral
• Report potential or actual patient safety concerns, medical errors, and/or near misses in a timely manner
• Complete psychosocial assessment of identified patients whose medical status, recovery, or timely discharge may be impeded by inadequate social, environmental, or economic conditions, by inadequate funding sources, and/or by impaired emotional or cognitive status including decisional incapacity
• Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"
• Provide case management and discharge planning services in a timely and cost-effective manner to include patient assessment, planning, implementation, coordination, monitoring, and evaluation
• Assess patient level of functioning including developmental, physical, environmental, cognitive, behavioral, psychological, economic, social, cultural, and spiritual factors
• Identify patients with a history of medical non-compliance, high resource utilization, and poor outcomes, monitor patient outcomes, re-evaluate plans of care to accommodate changes in treatment or progress
• Document assessment data, patient problems, interventions taken to achieve outcomes, and evaluation of patient progress toward targeted outcomes
• Serve as UNMHSC liaison to state protection agencies for all reports and/or concerns of patient abuse, neglect, or exploitation
• Coordinate with UNMHSC Office of Legal Counsel regarding matters involving treatment, guardianship, and/or other legal issues
• Coordinate multidisciplinary care planning including patient care conferences as appropriate to facilitate resolution of treatment decisions and timely discharge planning
• Develop and maintain positive relationships with community agencies and third-party payor sources
• Contribute to education of physicians, nurses, allied health professionals, and students
• Acts as resource to professional colleagues, provide staff training development, and consultation as appropriate
• Assist in resolution of identified barriers and develop alternative goals and objectives with patients and family members
• Use effective communication strategies with patients, families, physicians, nurses, allied professionals, and others to achieve desired patient outcomes and patient satisfaction
• Provide assistance to facilitate patient recovery, discharge, and/or management of an acute, chronic, or terminal illness or condition assistance may include education, community referrals, advocacy, and mediation with patients and families to assist in adjustment to changes in health status and functioning expediting timely discharge to an appropriate level of care
• Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable

Qualifications:

Education: Master's Degree in a related discipline

Experience: No minimum experience required

Credentials: NM LMSW or LPC or LCSW

Physical Conditions: Sedentary Work

Working conditions: No or min hazard physical risk, office environment, may be required to travel to various work sites, may be required or is required to perform on-call duties, may work rotating shifts, holidays, and weekends, Tuberculosis testing is completed upon hire and additionally as required